Betty R. Ferrell, PhD, RN


July 17, 2018

The correct response here would be to acknowledge that many patients choose to pray at times like these. As patients experience advancing disease, it is common for spiritual needs to change. Although clinicians may feel uncomfortable when bad news is shared, what patients most need is to express emotions, be heard, and have time for sadness. Maria should be respectful of Gwen's earlier choice to decline to speak with a chaplain, but it is important to re-evaluate spiritual needs and be responsive to changing reactions to serious illness. It is also important to consider Gwen's values and priorities in planning future care, and to recognize that new support may be needed as her illness progresses and she faces the possibility of death.

Spirituality and Religion

Spirituality has been defined broadly as "the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred."[1] A comprehensive assessment of a patient's needs includes an evaluation of spiritual needs. As in Gwen's case, spirituality changes over time. As patients face their own mortality, it is common for new issues, such as spiritual longing, forgiveness, reconciliation, and uncertainty, to emerge.

Patients often decline meeting with chaplains, especially early in the course of illness, because they may believe that a chaplain's presence indicates a poor prognosis. Those who have been part of a religious group that is different from the chaplain's may also decline spiritual support.

There is growing recognition that all clinicians require training to be prepared to assess and respond to spiritual needs.[2,3,4] Every discipline should be comfortable in communicating about spirituality, as it is often an aspect of patient distress. Provision of spiritual support is vital as patients face treatment decisions and the burdens and prognosis of serious illness.

Spiritual care, as with other psychosocial support, begins with professionals who attentively listen to the patient's fears and concerns and are willing to be a compassionate presence.[5]


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